Abscess

A retropharyngeal abscess forms in the potential space between the prevertebral fascia posteriorly, the posterior pharyngeal wall anteriorly, the carotid sheaths anteriorly, the base of the skull superiorly and the mediastinum inferiorly.

The origin is spread of infection from the teeth, middle ear or the sinuses. Peritonsillar abscess forms in the potential space between the palatine tonsil and the capsule. It can spread to include the masseter muscles and the pterygoid muscle.

The bacteria most commonly identified are streptococcus pyogenes, staphylococcus aureus, haemophilus influenzae and neisseria species and anaerobes [38-40].

Both present similarly with fever, sore throat and poor oral intake. Examination may reveal a neck mass, fever, cervical adenopathy, neck stiffness or torticollis, agitation, lethargy, drooling, trismus and stridor. In stable patients lateral soft tissue x-rays can show an enlarged  prevertebral soft tissue shadowing.

Children with airway compromise must be admitted for close monitoring with urgent incision and drainage of the abscess.

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